A study of spending patterns finds end-of-life healthcare spending begins far earlier than the last few months of a patient's life. Nearly half the Medicare patients studied had high spending throughout the entire final year of life.
Nearly half of Medicare patients' end of life healthcare spending begins a full year before their deaths rather in the few months prior to death, a study by University of Michigan researchers shows.
"We were expecting to find the most common pattern to be explosive healthcare spending in the final months of life. In fact, only 12% of older adults in our study showed this 'late rise' pattern of healthcare spending," said lead author Matthew A. Davis, PhD, MPH.
He is an assistant professor at the U-M School of Nursing and member of the U-M Institute for Healthcare Policy and Innovation, said in a news release.
The spending pattern was tied to multiple physician visits and regular hospitalizations for care of multiple chronic conditions rather than one specific disease.
Related: End-of-Life Care in Hospitals Has a Long Way to Go
After analyzing data from the Centers for Medicare & Medicaid Services, which included a sample of nearly 1.3 million Americans aged 66 to 99 who died between 2011 and 2012, Davis and his colleagues identified four end of life spending patterns:
High Persistent
Nearly half the Medicare patients studied had high spending throughout the final year of life.
They also had the highest Medicare costs—around $59,394—with twice as many outpatient visits to medical specialists as the three other groups.
They were more likely to spend time in hospitals, skilled nursing facilities, and use life-prolonging treatments like dialysis or feeding tubes.
Moderate Persistent
This group (29 % of patients studied) began their final year with moderately high amounts of spending, then spending dipped for a period of time, and then rose again in the last few months of life.
Their cost of care during the final year was $18,408.
Progressive
Only 10% of those studied fell into this group, but these patients had the second-highest costs, with a median of $37,036.
Their spending was very low at the beginning of the last year of life, but rose steadily throughout the year. They were also most likely to use hospice care.
Late Rise
This group (12% of those studied) spent just $11,166 in median health care costs in their final year.
They had very low health spending until a few months before they died, far lower numbers of physician visits and hospital stays, and no or few chronic conditions.
They were more likely to die during a hospital stay that included time in an ICU and had the second-highest use of life-prolonging treatments.
Conclusion
"Our research points to having to do a better job taking care of people who have multiple chronic conditions in a way that maintains or improves the quality of care they receive, but with cost in mind," Davis says.